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Thread: Amytriptyline startup

  1. #1

    Amytriptyline startup

    Hi
    Been on 200mg Trazodone for 2 years for anxiety over IBS issues. As it was no longer helping, GP suggested amytriptyline at a low dose for the IBS symptoms. Traz did nothing for the IBS btw
    As amytriptyline, is in same class, as Traz, was not allowed to take both, so Gp tapered me off quickly, over 2 weeks and started on Amytriptyline at 10mg. Apart from a rocky 1st week, I've been doing fine. (Until today, that is).
    Minimal anxiety and IBS greatly improved.
    However this morning (Day 12 of 10mg).
    Woke up with all usual anxiety symptoms. Feeling of dread, not able to go out, physical feelings, shaky, racing heart. negative thoughts etc. I thought I was doing so well, wondered why this should happen after almost two weeks of amytrip. Gp has said I can double the dose, if I feel I need to without seeing her.
    Not sure what to now. Whether to increase the dose, I almost feel I need to, or to wait it out a bit more and see if this is a blip.
    I really want be on the lowest dose I can get away with.
    Sorry for the long post.

  2. #2
    Join Date
    Jan 2017
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    Re: Amytriptyline startup

    Quote Originally Posted by Kitty Cat View Post
    Hi
    Been on 200mg Trazodone for 2 years for anxiety over IBS issues. As it was no longer helping, GP suggested amytriptyline at a low dose for the IBS symptoms. Traz did nothing for the IBS btw
    As amytriptyline, is in same class, as Traz, was not allowed to take both, so Gp tapered me off quickly, over 2 weeks and started on Amytriptyline at 10mg.
    There is no reason why you couldn't take a small dose of amitriptyline with trazodone. Trazodone has only minor impact on serotonin reuptake (which is probably why it did nothing for the IBS) and none on noradrenaline/norepinephrine, the two pathways principally affected by TCAs like amitriptyline.

    Apart from a rocky 1st week, I've been doing fine. (Until today, that is).
    Minimal anxiety and IBS greatly improved.
    However this morning (Day 12 of 10mg).
    Woke up with all usual anxiety symptoms. Feeling of dread, not able to go out, physical feelings, shaky, racing heart. negative thoughts etc. I thought I was doing so well, wondered why this should happen after almost two weeks of amytrip. Gp has said I can double the dose, if I feel I need to without seeing her.
    I'm not surprised anxiety is rearing its ugly head as 75mg is the minimum recommended dose for anxiety and depression with most taking 100-150mg. The other issue is that it can take up to 12 weeks for antidepressants (ADs) to fully kick-in. An initial increase in anxiety is also common when taking serotonergic ADs.

    Not sure what to now. Whether to increase the dose, I almost feel I need to, or to wait it out a bit more and see if this is a blip.
    I really want be on the lowest dose I can get away with.
    I think you need to get a second opinion.
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  3. #3

    Re: Amytriptyline startup

    Thank you so much panic down under. I was thinking this myself. Not much faith in GP at the moment. But sure where to get another opinion in from though. I feel amytrip is the drug for me, As had success with other TCA in the past

  4. #4

    Re: Amytriptyline startup

    Been taking amytriptyline for IBS and anxiety issues, but got a bit of a dilemma now.
    I've been on amytriptyline for 10 months, at a fairly low dose, to help with IBS. I can say it has helped with my IBS, I suffer from urgency and a tendency to have accidents😒 sorry if TMI! I also have GAD which is made much worse if I get an IBS flare.
    Just recently I have found anxiety coming back on a daily basis, but the IBS is under control.
    Gp has suggested, switching AD to Venlafaxine, to help with anxiety, but I'm not sure of its effect on bowels.
    I'm on 40mg of Amytriptyline per day at the moment, which doesn't seem a lot, but I do suffer with some of the side effects of a TC, particularly weight gain, dry mouth, and palpitations.
    Would going lower on the Amytriptyline and adding Venlafaxine help, or should I increase the amytriptyline a bit more and see if the side effects get any worse.
    I'm very reluctant to leave tbe amytriptyline, as it has enabled me to go out and live my life. But this latest flare up of anxiety is starting to get to me.

  5. #5
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    Re: Amytriptyline startup

    The lowest dose of Ami (10 mgs) should be enough to get the IBS symptoms under control. At this dose it also helps with sleep but will do nothing for anxiety. I've been on this low dose for 25+ years.
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  6. #6
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    Re: Amytriptyline startup

    Quote Originally Posted by Kitty Cat View Post
    Gp has suggested, switching AD to Venlafaxine, to help with anxiety, but I'm not sure of its effect on bowels.
    I'm not a fan of venlafaxine. It has a number of potential issues including being to hardest AD to quit. Despite the SNRI claim it is really only a SSRI and any of those would be a better option, imho. Citalopram, or escitalopram would be the pick if you wanted to go down the SSRI path.

    I'm on 40mg of Amytriptyline per day at the moment, which doesn't seem a lot, but I do suffer with some of the side effects of a TC, particularly weight gain, dry mouth, and palpitations.

    Would going lower on the Amytriptyline and adding Venlafaxine help, or should I increase the amytriptyline a bit more and see if the side effects get any worse.
    Increasing the amitriptyline dose would be the easiest option and likely to be the fastest to work on your anxiety. Another option would be to switch to imipramine which is also effective for IBS, but generally has less impact on weight and the muscarinic acetylcholine side-effects such as dry-mouth and constipation although, as with all things antidepressant, YMMV.
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

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